Individual
MR. CRAIG M GORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5191-024
WI
2251G0304X
Geriatric Physical Therapist
5191-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40260200
—
WI
Enumeration date
05/03/2007
Last updated
11/09/2007
Update your record
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